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Clone of Alcohol during pregnancy - narrative and media representation of the issues

Submitted by gmp26 on Sun, 27/04/2008 - 1:35pm

Background

Advice regarding pregnancy-related health issues and lifestyle choices has been given for a long while, so in a sense there is no true start to this story. The issues discussed here relate to the previous NICE guidelines, issued in 2003, which advised caution, but not complete abstinence from alcohol, and which did not differ too much in style and content to the advice issued by the Department of Health at the same time.

However, in May 2007, the Department of Health published its latest edition of the “pregnancy book”, which advised pregnant women to abstain completely, because there is no evidence where the safe limit really lies, while in October 2007 NICE released a draft of the new guidelines which were to be released in March 2008. These draft guidelines did not differ substantially from the earlier guidelines, which advised caution, but not abstinence.

The reports in the national press
After the NICE draft guidelines were shown to the press around 11th October 2007 almost every UK broadsheet picked up on the apparent contradiction between the advice given by the DoH and NICE. Interestingly, apart from the Daily Mail, the story was not picked up by the tabloids.

In the Daily Telegraph the story was headlined as “A daily tipple is safe for women”, and starts by summarising the advice from the draft NICE guidelines, but then pointed to the contradictions with the DoH advice. It highlighted the fact that the DoH guidelines themselves have recently been changed “amid fears that women were either ignoring advice that they could consume a little, had various ideas of what the recommended amount was, or were being given different advice in different parts of the country.” Therefore the contradicting advice itself is explained as a recourse to the precautionary principle, rather than discussed in terms of conflicting messages.

As a contrast, the Guardian reported the confusion as the main message of the story, headlined “Confusion over advice on alcohol for pregnant women”, and launched straight into the fact that the two agencies have issued conflicting advice. Interesting here is their own interpretation of the NICE guidelines: even though these guidelines were carefully worded so that they still suggest that alcohol should best be avoided (see above), the Guardian's interpretation was to set out the advice in a way in which it was probably never intended: "In practice, this would mean the green light for women to drink one small glass of wine a day, or half a pint of 5% lager or strong cider, or a bottle of alcopop. "

Here as well the article points to the precautionary principle being applied. They quote a consultant obstetrician from UCL, Pat O'Brian, explaining the thinking behind the DoH advice: "There was some evidence at that time that some women were drinking more than the recommended allowance. They took that stance because they felt that in population terms it was the best way of deterring women from drinking too much in pregnancy."

The Times similarly highlights the conflicting advice in their highly sarcastic headline “Pregnant women told glass of wine a day is fine - and too dangerous”. It starts by outlining the new NICE guidelines, followed by an explanation of their reasoning. However, the actual advice gets slightly distorted in a way that highlights the difference between the two sets of guidelines and disregards NICE's actual assessment of the available evidence: “The experts [at NICE] concluded women should avoid alcohol only during the first trimester, but said drinking led to a slightly higher risk of miscarriage.” In fact the original report also states that the evidence for a higher risk of miscarriage is “limited and of poor quality” (NICE 2007: 103). Also, the original wording of the NICE advice was that “women should limit their alcohol intake [after the first trimester] to less than one standard drink” (ibid, my emphasis), where here the actual emphasis suggests much more caution than the Times paraphrases.

The article also concludes with expert quotes, this time from the Royal College of Obstetricians and Gynaecologists and the BMA, both of which highlight the precautionary principle in a similar manner to the DoH. Especially the BMA report was quoted as expressing “concern that any relaxed guidelines could be misinterpreted, as the varying alcoholic strengths or standard measures of different beers and wines can make it difficult for women to tell how many units they are consuming”, thereby explaining some of the reasoning behind the DoH's application of the precautionary principle.

The Daily Mail also focuses on the confusion. The reporting follows similar lines to the other newspapers quoted above: highlighting the conflict, using possibly slightly misleading quotations similar to those in the Times (by omitting the comments on the quality of the evidence), and closed by comments from experts and charities, some of them stressing the reasoning behind the DoH advice. This article is different from the other ones in that it also includes a quote on the reasoning behind the NICE guidelines: [Dr David Williams] said: 'I think the NICE advice is accurate according to the data we have got – a total ban is not a good thing. Most claim research shows that even very small amounts of alcohol can damage the health of the unborn child.

What is remarkable about this quotation is that it contradicts itself – this could possibly be a result of a typo, because the quotation marks that open Williams' quotation do not close, and the second part of the quotation above only makes sense if seen to be outside quotation marks. Therefore, even though the Mail article is the only one so far to quote somebody sympathetic to NICE's reasoning, the quotation as printed gets distorted and contradicts itself!.

The dissemination of this and similar stories through opinion articles and responses to them

While there was no extensive op-ed coverage following the NICE story, several opinion pieces in the national press had already been published as a reaction to the DoH's advice in May 2007, which contradicted the previous DoH advice. Several newspapers, such as the Daily Mail and the Times, invited public comments, blog-style, to react to the story on their websites. The discussion in these forums followed the discussions in the earlier comment pieces both in style and substance (bearing in mind, however, that the Mail heavily edits comments to comply with their editorial stance).

The main argument of a Guardian op-ed on the 25 May 2007 was that the new DoH advice was patronising to most responsible mothers, because with the lack of conclusive evidence for safe doses, the precautionary advice was only really aimed at “the 9% of women who still drink above the previous recommended levels” (Curtis 2007 ). The Times report, also of the 25 May invited comments that made similar arguments to the ones made by Curtis and her commentators.

Commentary fell into several categories. Firstly, there were opinions for and against the precautionary advice. But there were also several other recurring themes. One was the argument that drinking alcohol is a choice (unlike for example passive smoking, or, as in one particular comment to the Curtis article, stepping into a car – the extent to which the latter was necessary or a choice then became an interesting side-discussion). This argument even took on moral tones, as some commentators argued that alcohol is bad for you in any case - so why should potential harm to a child be tolerated for the sake of an unhealthy and possibly immoral activity?